Journal of advanced nursing
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Many patients continue to suffer moderate pain following surgery. Much of this may be unnecessary and could be alleviated with careful strategic pain management. It appears that the knowledge and attitudes of both health care professionals and patients are pivotal to patients' pain experiences. ⋯ Improvements in pain management can be made by embracing basic pain management principles.
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Postoperative pain is an expected phenomenon. However, its passage beyond acceptable limits is a common and costly experience. This is particularly the case in day surgery, partly because of the increasing demand to reduce waiting lists for elective surgery, and partly because of lack of knowledge about patients' experiences of postoperative pain and relevant published research. The latter is mainly concerned with different interpretations of the phenomenon of pain that appear to have led to a variety of often inappropriate pain measurement tools. ⋯ Common guidelines on the definition and measurement of pain are needed. In day surgery, the availability of a unified and reliable measure of pain that can address its sensory component, such as the VAS, will provide more reliable information about the pain experience and, hence, improve its overall management.
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Despite technological advancements in anaesthesia and analgesia, reported pain levels after day surgery remains high. Whilst it is unrealistic to expect no pain, the level that constitutes 'acceptable' pain remains unclear because of inconsistencies in reporting. These inconsistencies have resulted from different interpretations of what pain is and the use of different measurement tools. ⋯ There is a disparity in reported levels of pain after day surgery. It is important that a unified day surgery pain measurement strategy is established, so that patients can be informed about the intensity of pain that they are likely to experience following specific procedures.
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Numerous studies have employed the Delphi technique to seek expert opinion about aspects of clinical practice. When researching literature on the Delphi technique, however, we discovered discrepancies in its application, and a lack of detail when reporting design, administration, and analysis methods. Such lack of specificity hinders the replicability and assessment of the clinical and cultural validity and reliability of Delphi studies. ⋯ When rigorous methods of participant selection, group composition, participant feedback, and determination of consensus and importance are employed, the Delphi technique is a reliable, cost-effective means of obtaining and prioritizing experts judgements.
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No comprehensive review has been published to date, which provides information for nurses on pharmaceutical alternatives to morphine in palliative care. As nurses are often the health professional most involved with terminally ill patients, there is a clear need for a review of current practices which is accessible to nurses. ⋯ Nurses need to be aware of treatment options that may benefit patients with difficult pain problems. Although positive experiences have been documented when using alternatives to morphine, more research must be conducted to allow practitioners to add more pharmaceutical alternatives to their pain management armouries.